Sahbudin, IlfitaSingh, RuchirTrickey, JeanetteBaranskaya, AliaksandraTracy, AlexanderRaza, KarimFiler, AndrewJowett, SueBoonen, Annelies2023-09-052023-09-052023-04-13Sahbudin I, Singh R, Trickey J, Baranskaya A, Tracy A, Raza K, Filer A, Jowett S, Boonen A. Is symptom duration before DMARD therapy a determinant of direct and indirect costs in DMARD-naïve RA patients? A systematic review. Rheumatol Adv Pract. 2023 Apr 13;7(2):rkad040. doi: 10.1093/rap/rkad042514-177510.1093/rap/rkad04037197378http://hdl.handle.net/20.500.14200/2087Objective: Early treatment of RA improves clinical outcomes; however, the impact on health economic outcomes is unclear. This review sought to investigate the relationship between symptom/disease duration and resource utilization/costs and the responsiveness of costs following RA diagnosis. Methods: A systematic search was performed on Pubmed, EMBASE, CINAHL and Medline. Studies were eligible if patients were DMARD-naïve and fulfilled 1987 ACR or 2010 ACR/EULAR RA classification criteria. Studies had to report symptom/disease duration and resource utilization or direct/indirect costs as health economic outcomes. The relationships between symptom/disease duration and costs were explored. Results: Three hundred and fifty-seven records were identified in a systematic search; nine were eligible for analysis. The mean/median of symptom/disease duration in studies ranged between 25 days and 6 years. Annual direct costs of RA following diagnosis showed a U-shaped distribution in two studies. Longer symptom duration before starting a DMARD (>180 days) was associated with lower health-care utilization in the first year of RA diagnosis in one study. Annual direct and indirect costs 6 months before RA diagnosis were higher in patients with shorter symptom duration (<6 months) in one study. Given the clinical and methodological heterogeneities, the association between symptom/disease duration and costs after diagnosis was not computed. Conclusion: The association between symptom/disease duration at the time of DMARD initiation and resource utilization/cost in patients with RA remains unclear. Health economic modelling with clearly defined symptom duration, resource utilization and long-term productivity is vital to address this evidence gap.en© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.Practice of medicinePublic health. Health statistics. Occupational health. Health educationArticle